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Topic: Secondary diagnosis codes on CMS1500 (Read 10335 times)

When I need to use a secondary diagnosis code for a CPT Code, do I list the primary diagnosis code first with the diagnosis pointer "1" and then do not use a diagnosis pointer of "2"? Therefore, in box 21 of the CMS 1500 form it would show an extra diagnosis code, but no diagnosis pointer identifying it. Is this correct? I am having a hard time finding any information telling me as to how this is done. Am I correct that the insurance company will see that the diagnosis pointer "1" is the primary and any additional codes in either 2, 3, or 4 would be secondary, third or fourth diagnoses? Can someone please help?

So does this mean that the primary diagnosis code for 99213 would be 250.00 as primary, followed by 496 as secondary and 401.1 would be third? And, the only diagnosis code for 93000 would be 401.1?

Am I correct to assume that for each procedure code, whichever order you put the diagnosis pointers indicates to the ins. co. which diagnosis code is 1, 2, 3 or 4th and so on? And, it's not necessarily the number of the diagnosis pointer, but rather the order in which they are listed in the diagnosis pointer column?

Ok...thanks. I'm beginning to understand a little better. Here is an example. Can you tell me if this seems correct? (The ICD-9 says I must first code 250.51 before using 362.01 on the fundus photography).

1. 250.51 (Diabetes w/ Complications)

2. 362.01 (Diabetic Retinopathy)

92014 (Comprehensive Exam) 1 292250 (Fundus Photography) 1 2

I pointed the dx pointer of 1 & 2 to the exam because they are both related to the exam and the dx pointer of 1 & 2 to the photo (92250) because the code book said I must first use the 250.51 code, then the 362.01. Correct?